TC106A TAX COMMISSION OF THE CITY OF NEW YORK 2021/22 1 Centre Street, Room 2400, New York, NY 10007

APPEAL OF DENIAL OF A SENIOR CITIZEN OR DISABLED HOMEOWNER’S EXEMPTION

BEFORE BEGINNING THIS FORM, READ TC600PE AND ALL INSTRUCTIONS ON THE BACK OF THIS FORM. COMPLETE ALL PARTS AND ANSWER ALL QUESTIONS. THE APPLICATION MUST BE RECEIVED BY THE TAX COMMISSION BY MAY 31, 2021. YOU MUST ATTACH A COPY OF THE EXEMPTION APPLICATION YOU FILED WITH THE FINANCE DEPARTMENT AND A COPY OF THE NOTICE YOU RECEIVED DENYING OR REVOKING AN EXEMPTION. 1. PROPERTY IDENTIFICATION BOROUGH (Bronx, Brooklyn, Manhattan, Queens or Staten Island) BLOCK LOT ASSESSMENT YEAR 2021/22 Type of Residence (check one):  1-, 2-, 3-family dwelling or condominium unit  Cooperative unit. Enter apartment # ______ Other (please specify): ______What percentage of space at the property is used as your primary residence? :______% FULL ADDRESS OF PROPERTY INCLUDING ZIP CODE AND APARTMENT NO.: ______2. OWNER INFORMATION - The applicant must be an owner using the property as their primary residence. Name of owner ______Date of purchase ____/___/___ Social Security Number ______--______--______Date of Birth _____/_____/______Yes  No  Are there other owners? If “YES”, a completed TC106SUP form for each owner must be attached to this application. LEAVING THIS QUESTION BLANK WILL RESULT IN AN AUTOMATIC DENIAL OF YOUR APPEAL. 3. CONTACT INFORMATION FOR OWNER PHONE NO. NAME OF PERSON TO BE C ONTAC TED

MAILING ADDRESS EMAIL ADDRESS

4. SENIOR EXEMPTION (SCHE) (YOU CANNOT GET BOTH SCHE & DHE. If you qualify for both you will receive SCHE) Yes  No  This property is my primary residence Yes  No  I am receiving an exemption on another property My household income for 2019 was $______(See instructions to calculate. Household income is not the same as adjusted gross income.) Proof Attached: Check each type of proof attached. No appeal will be reviewed without the required proof.  Proof of age: Copy of a government-issued ID such as a driver’s license, passport or birth certificate.  Proof of income: Copies of your complete and signed 2019 federal tax returns or other proof of 2019 income and an explanation as to why any owner is not required to file a federal return. STATE RETURNS, TAX RETURN TRANSCRIPTS OR FORM 1040X ARE NOT ACCEPTABLE.  Copies of receipts for unreimbursed medical or prescription expenses. You must provide a total for all expenses. See instructions.  Copy of application to the Finance Department seeking this exemption.  Copy of the Finance Department’s denial or revocation notice. 5. DISABLED HOMEOWNER EXEMPTION (DHE) Yes  No  This property is my primary residence and is NOT a limited profit housing company, limited dividend housing company, Mitchell Lama, redevelopment company or HDFC property. Contact your management company or property manager if you do not know. Yes  No  I am receiving an exemption on another property My household income for 2019 was $______(See instructions to calculate. Household income is not the same as adjusted gross income.) Proof Attached: Check each type of proof attached. No appeal will be reviewed without the required proof.  Proof of disability: Copy of one of the following for each owner: the 2019 award letter from the Social Security Administration, the Railroad Board or the U.S. Postal Service, or a Certificate from the State Commission for the Blind and Visually Handicapped. See instructions.  Proof of income: Copies of your complete and signed 2019 federal tax returns or other proof of 2019 income and an explanation as to why any owner is not required to file a federal return. STATE RETURNS,TAX RETURN TRANSCRIPTS OR FORM 1040X ARE NOT ACCEPTABLE.  Copies of receipts for unreimbursed medical or prescription expenses. You must provide a total for all expenses. See instructions.  Copy of application to the Finance Department seeking this exemption.  Copy of the Finance Department’s denial or revocation notice. 6. ATTACHMENTS - List all documents attached. Number the pages.

______Last page number ______7. OATH This application must be signed by the applicant or by an individual authorized to sign by a valid power of attorney from the applicant. A copy of the power of attorney must be attached. I have read this form and all relevant instructions, whether on this form, or on another. I certify that all statements made on this application, and on any attachments, are true and correct to the best of my knowledge and belief, and I understand that such statements are being relied upon by the City of New York, and that they are subject to verification. I have read this entire form before signing it. I am personally responsible for the accuracy of the information provided on this application, and any attachments. I also understand that the making of any willful false statement of material fact on this application including the attached sheet(s) will subject me to the provisions of the penal law relevant to the making and filing of false statements. Print name: ______Signed: ______Date:______The signer must appear and acknowledge the signature before a notary. Sworn to before me: County ______State ______Date: ______NOTARY STAMP Signature of person administering oath ______INSTRUCTIONS This application only can be used to appeal a denial or revocation of a Senior (SCHE) or Disabled Homeowner’s exemption (DHE) by the Department of Finance. This application cannot be used to protest the assessed value of the property or eligibility for any other exemption.

If: (i) you applied for a SCHE or DHE exemption and the Department of Finance sent you a letter stating that you are NOT eligible to receive either exemption, or Finance granted you a smaller exemption percentage than you believe you are entitled to, or (ii) you had a SCHE or DHE exemption and the Department of Finance has revoked it for the 2021/22 tax year, you can protest that denial or revocation by submitting this application to the New York City Tax Commission by May 31, 2021.

You can mail or deliver by hand this application to the Tax Commission’s office at: 1 Centre Street, Room 2400, New York, NY 10007, or to one of the Department of Finance business centers. Your application must be received by May 31, 2021.

However, if the notice you received from the Department of Finance denying or revoking a SCHE or DHE exemption for your property for the 2021/22 tax year was dated after May 1, 2021, you can file form TC106A to request Tax Commission review within 30 days of the date of the Finance Department notice.

SECTION 1 - Your Borough, Block and Lot can be found on the letter you received from the Department of Finance.

SECTION 2 - Your Social Security Number and Date of Birth are required. Your Social Security Number will not be disclosed. If there is more than one owner, each additional owner must complete a TC106SUP form that must be attached to this form, and provide proof of their 2019 income.

SECTIONS 4-5 – To qualify for SCHE, ALL owners of the property must be 65 by December 31, 2021, except for an o wner who is the spouse or sibling of an owner who will be 65 by December 31, 2021. Proof of age is required. To qualify for DHE all owners of the property must be disabled, except for an owner who is the spouse or sibling of an owner with a disability. Proof of disability is required.

All owners must certify that the property is their primary residence except a spouse or former spouse who is not a resident due to a divorce, separation or abandonment, or an owner who is not a resident because the owner is receiving health related services as an inpatient of a resident health care facility. Proof of such inpatient residence must be submitted. You can only have one primary residence in any given year.

Total combined income (not adjusted gross income) for all owners must be less than $58,400. You must provide proof of income for calendar year 2019 for all owners (other than a spouse or former spouse who is not a resident due to a divorce or separation). Attach a complete, signed copy of each owner’s 2019 federal income tax return including all schedules and attachments. State tax returns are not acceptable. If any owner was not required to file a federal or state tax return for 2019, please attach a list of all owners who were not required to file with an explanation as to why no filing was required and submit proof of income for each such owner (e.g., copies of W-2 forms, Social Security, 1099 forms). Proof of income for any year besides 2019 will not be considered.

Under state law nontaxable social security and pension amounts are included. The one major category that is deducted from total combined income is unreimbursed medical expenses incurred in 2019. The Tax Commission will deduct unreimbursed medical or prescription drug expenses including medical insurance premiums, but only if you BOTH attach proof for all such expenses, AND provide a total of such expenses. Unpaid expenses are not deductible, and bills are not acceptable proof.

DISABILITY INFORMATION. To qualify for DHE, all owners must submit proof of disability except an owner who is a spouse or sibling of an owner who is disabled. Owners receiving any of the following forms of disability-related financial assistance: (1) Social Security Disability Insurance (SSDI); (2) Supplemental Security Income (SSI) benefits; (3) Railroad Retirement Disability Benefits (RRDB); (4) Disability pension from the US Postal Service; or has a certificate from the State Commission for the Blind and Visually Handicapped stating that he/she is legally blind, must submit a copy of at least one of the following documents: the 2019 award letter from Social Security Administration; the 2019 award letter from the Railroad Board; or U.S. Postal Service, or certificate from the State Commission for the Blind or Visually Handicapped. Do not submit original documents.

SECTION 6 – List all attachments and number all pages. You may attach any other information you believe relevant to dispute the reason given by the Finance Department for denying or revoking the exemption.

QUESTIONS? Email [email protected]